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of interventions for HIV infection and other STDs, in particular, is an important aspect of an effective national system.
An effective national system for STD prevention should: (a) provide comprehensive curative and noncurative preventive services; (b) provide STD-related services in the context of primary care; (c) coordinate public and private sector services; (d) coordinate local, state, and federal programs; and (e) ensure universal access to STD-related services for all persons in the United States. The committee proposes a model for carrying out the functions of a national system for prevention in the context of community and individual roles and responsibilities in Figure 6-1.
In the context of the model, the term "community" refers to all persons and entities that have a potential role in STD prevention besides the individual. The committee's model is based on the recognition that both individuals and the community have a role and responsibilities in preventing STDs. In some cases, such as reducing high-risk behaviors, the degree of individual responsibility may exceed that of the community. Even then, however, the community plays a role in setting social norms and providing the knowledge and resources needed for behavior change to occur. In other cases, such as ensuring access to health care, the community's responsibility is clearly greater. Many responsibilities and functions are best shared; many overlap and are related; and some will likely change as the system evolves or as conditions warrant. In addition, responsibilities for specific functions need to be tailored to the local community environment. In the case of STDs, the committee believes that communities have a special responsibility to become involved because STDs and other communicable diseases threaten the health of the community at large, not just the infected individual. In addition, many of the underlying factors that contribute to the STD epidemic, such as lack of awareness, lack of access to health care, and unbalanced messages regarding sexual behavior, are most effectively addressed through community-based interventions.
The committee believes that it is inappropriate to advocate that the STD epidemic be solved by individuals without the support of community interventions. It is the community's responsibility to provide individuals with the support, information, and tools that are needed to prevent STDs. Many factors that are often beyond the control of the individual, especially sociocultural factors, directly influence individual behavior and risk of STDs (Wasserheit, 1994).
It has been proposed that the various biomedical and behavioral health professionals currently involved in STD prevention, including clinicians, epidemiologists, public health workers, microbiologists, psychologists, and social scientists, develop and participate in interdisciplinary approaches to prevention (Sparling and Aral, 1991). The committee proposes that an even wider range of individuals and institutions is needed. In addition to the professionals mentioned above, health plans, pharmaceutical and medical device companies, educators, and other individuals and entities that have not traditionally been involved in